SEC Form 4
FORM 4 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
1. Name and Address of Reporting Person*
Army Joseph

(Last) (First) (Middle)
100 DOMAIN DRIVE

(Street)
EXETER NH 03833

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
VAPOTHERM INC [ VAPO ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
X Officer (give title below) Other (specify below)
President and CEO
3. Date of Earliest Transaction (Month/Day/Year)
01/11/2019
4. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3) 2. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 3. Transaction Code (Instr. 8) 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V Amount (A) or (D) Price
Common Stock 01/20/2020 A 500 A $0 500(1) I By spouse
Common Stock 709,921(2) D
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 3) 2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (Month/Day/Year) 3A. Deemed Execution Date, if any (Month/Day/Year) 4. Transaction Code (Instr. 8) 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) 6. Date Exercisable and Expiration Date (Month/Day/Year) 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) 8. Price of Derivative Security (Instr. 5) 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) 10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 11. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Employee Stock Option (right to buy) $17.15 01/11/2019 A 198 (3) 01/11/2029 Common Stock 198 $0 198 I By spouse
Explanation of Responses:
1. Consists of 500 shares that will be issued over time upon vesting pursuant to a restricted stock unit granted to the Reporting Person's spouse under the Vapotherm, Inc. 2018 Equity Incentive Plan provided the Reporting Person's spouse continues to serve as an employee or other service provider to the Issuer on the vesting date. The Reporting Person's spouse is an employee of the Company and the restricted stock unit grant she received was in connection with that role and consistent in amount with that role.
2. Includes 27,700 shares that will be issued over time upon vesting pursuant to a restricted stock unit granted to the Reporting Person under the Vapotherm, Inc. 2018 Equity Incentive Plan.
3. This option is held by the Reporting Person's spouse, was granted under the Vapotherm, Inc. 2018 Equity Incentive Plan and is eligible to vest with respect to 25% of the underlying shares on January 11, 2020 and thereafter as to the remaining 75% of the underlying shares in 36 nearly equal monthly installments, provided the Reporting Person's spouse continues to serve as an employee or other service provider to the Issuer on each vesting date. The Reporting Person's spouse is an employee of the Company and the option grant she received was in connection with that role and consistent in amount with that role.
/s/Adrain Bryant, as Attorney In Fact 04/27/2021
** Signature of Reporting Person Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction 4 (b)(v).
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
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